Feasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi-vessel coronary artery disease triggered by breathing maneuvers

Abstract

BackgroundHyperventilation with a subsequent breath-hold has been successfully used as a non-pharmacological vasoactive stimulus to induce changes in myocardial oxygenation. The purpose of this pilot study was to assess if this maneuver is feasible in patients with multi-vessel coronary artery disease (CAD), and if it is effective at detecting coronary artery stenosis > 50% determined by quantitative coronary angiography (QCA).MethodsTwenty-six patients with coronary artery stenosis (QCA > 50% diameter stenosis) underwent a contrast-free cardiovascular magnetic resonance (CMR) exam in the time interval between their primary coronary angiography and a subsequent percutaneous coronary intervention (PCI, n = 24) or coronary artery bypass (CABG, n = 2) revascularization procedure. The CMR exam involved standard function imaging, myocardial strain analysis, T2 mapping, native T1 mapping and oxygenation-sensitive CMR (OS-CMR) imaging. During OS-CMR, participants performed a paced hyperventilation for 60s followed by a breath-hold to induce a vasoactive stimulus. Ten healthy subjects underwent the CMR protocol as the control group.ResultsAll CAD patients completed the breathing maneuvers with an average breath-hold duration of 48 ± 23 s following hyperventilation and without any complications or adverse effects. In comparison to healthy subjects, CAD patients had a significantly attenuated global myocardial oxygenation response to both hyperventilation (− 9.6 ± 6.8% vs. -3.1 ± 6.5%, p = 0.012) and apnea (11.3 ± 6.1% vs. 2.1 ± 4.4%, p < 0.001). The breath-hold maneuver unmasked regional oxygenation differences in territories subtended by a stenotic coronary artery in comparison to remote territory within the same patient (0.5 ± 3.8 vs. 3.8 ± 5.3%, p = 0.011).ConclusionBreathing maneuvers in conjunction with OS-CMR are clinically feasible in CAD patients. Furthermore, OS-CMR demonstrates myocardial oxygenation abnormalities in regional myocardium related to CAD without the use of pharmacologic vasodilators or contrast agents. A larger trial appears warranted for a better understanding of its diagnostic utility.Trial registrationClinical Trials Identifier: NCT02233634, registered 8 September 2014.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0446-y) contains supplementary material, which is available to authorized users.

Cardiovascular magnetic resonance native T2 and T2* quantitative values for cardiomyopathies and heart transplantations: a systematic review and meta-analysis

“…The ROI location was one of the covariates and therefore an additional analysis was performed where the reported T 2 values were divided in infarct zone and infarct core groups. Infarct zone T 2 values were reported in 18 studies [26,40,43,51,53,54,[56][57][58][60][61][62][63][64][65][66][67][68]. The weighted mean T 2 value at 1.5 T of infarct zones was 63.7 ± 6.4 ms and at 3 T this was 63.5 ± 10.5 ms (Fig.…”

“…5). At 3 T, these were 60.3 ± 9.7 ms in MI patients and 44.0 ± 3.8 ms in controls [51,[64][65][66][67][68] (Table 1, Fig. 6).…”

“…6). Most studies restricted their inclusion to STEMI patients [40, 41, 43, 49, 51, 54-60, 63-65, 68], however some studies included specifically NSTEMI patients [52,62,67] and others included both STEMI and NSTEMI patients [26,53,61,66]. Besides two studies [52,62], patients in all studies underwent CMR post-PCI in the acute phase and a few studies also included follow-up data [40,42,43,49,53,64].…”

Hyperoxia—a Wolf in Sheep's Clothing?

“…Patients adapt quite variably throughout the course of CAD and thus show heterogenous responses to vasoactive stimuli such as hyperoxia 11 and hypercapnia. 15 Even in patients who have been treated for CAD, distal microvascular dysfunction still may be present and may contribute to adverse events during general anaesthesia. Randomized perioperative and long-term outcome studies in well-defined cohorts therefore are needed.…”

“…Preceding changes of the myocardial tissue oxygen balance can be detected noninvasively with OS-CMR, and this is feasible in most patients who do not have contraindications for magnetic resonance imaging scans. 15,16 So far, CMR studies remain a time-and resource-intensive modality and are not performed routinely. As a perspective for the future, however, OS-CMR may become a valuable tool to assess potential triggers of perioperative myocardial injury in patients at risk, with hyperoxia prominently among them.…”